Insurance & Financial


Kofinas Fertility Group’s financial counselors will help you afford to start an amazing family.


Navigating the financial aspects of fertility care is typically the last thing anyone wants to deal with when they’re struggling to bring home a child. We at Kofinas Fertility Group in New York completely understand your reluctance, which is why we’ve done everything possible to make the payment and insurance processes involved with your care as upfront and smooth as possible. It’s important for you to focus on your future child, not the formalities and technicalities of modern medical care.

 

Consult with our knowledgeable and compassionate financial counselors.

In order to help facilitate your payment and insurance questions, you will meet with one of our financial counselors who will help you work out the details of your care. Our counselors are familiar with a wide range of different insurance plans, and they’ll work with you to figure out a plan that’s right for your budget.

If you don’t have insurance, or your insurance doesn’t cover fertility care, don’t despair. We offer a number of different fertility care plans and packages that maximize the cost-effectiveness of your treatment. Also, your financial counselor will guide you through the options available to you. Like everyone else at Kofinas Fertility Group, our financial counselors want nothing more than to see you finally achieve a successful pregnancy and start a wonderful new chapter in your life. If there’s a way to get you the care you need, we’ll figure it out.

 

Financial information for Kofinas Fertility Group is conveniently available online.

We’ve compiled all pertinent financial information into the following web pages. Learn about each topic by clicking the appropriate link:

  • Cost & payment – Get prices for each of our advanced fertility treatments as well as for package offers. We explicitly tell you what each treatment plan does and does not cover in order to decrease stress due to potential unknown costs.
  • Insurance – Insurance coverage for fertility treatments can be hit-and-miss. For example, some insurance plans will cover fertility assessments but not therapies. On this page, we’ll give you the full story on insurance coverage as it pertains to our care.
  • The IVF cycle fee includes One (1) fresh cycle and unlimited frozen cycles (using all frozen embryos) until a viable 14 week pregnancy is achieved.

Proper HealthCare Lending Fertility Procedures and Surrogacy

If you have any questions about the financial aspects of fertility care, or to request an appointment,
call  212-878-7677. You can also request an appointment using our easy  online form.

Building New York families with competitive pricing on fertility treatments

We at Kofinas Fertility Group understand that fertility treatment can be financially and emotionally stressful. We want you to keep your focus on starting a new chapter in your life, not the cost of your treatment. This is why we make sure our patients have a clear understanding of fees prior to the beginning of their treatment. Additionally, we want to ensure that our patients are fully informed regarding all financial options available to them.

 

Our goal is to do everything possible to ensure that the expense of fertility treatment does not factor into your treatment decisions. We do have options for patients without fertility insurance coverage that can make treatment more affordable and reduce your stress.

 

We offer an Insured IVF Success Program and third-party financing options.

 

Fertility programs, costs and what’s included in your care.

The costs of our affordable fertility programs are designed to give you the most accessible path to the family of your dreams.

For more information about our ovulatory function evaluation process, or to request an appointment,
call  718-736-2218. You can also request an appointment using our easy  online form.

Insurance information for Kofinas Fertility Group in New York.

Fertility testing and treatments can be expensive and therefore require careful consideration and thorough understanding of the treatment options, costs involved, insurance coverage, and out-of-pocket expenses. We are very sensitive to the high cost of infertility treatment and the lack of coverage by most insurance plans. We are dedicated to keeping the costs of our services affordable for those who need our help.

We also offer several financial programs for patients who seek treatment but do not have insurance coverage.

 

Fertility Insurance Mandate

The Fertility Mandate, starting January 2020, is now being covered by large group insurance plans. Click below to learn more about the mandate and how it could help you.

 

Insurance coverage

Insurance coverage ranges from nonexistent to comprehensive. Each insurance company offers many different plans, and each plan has different policies regarding fertility coverage.

Understanding insurance benefits can be confusing for many people, especially when exploring fertility coverage. In most cases, those patients fortunate enough to have fertility coverage with their insurance plan are limited to a certain dollar amount or number of treatment cycles. It is important to review your insurance plan and make sure you understand what is paid for and what it is not. Always follow the guidelines regarding referrals and filing claims to guarantee the maximum allowable benefits.

To help you understand and anticipate any benefit difficulties that you may encounter, please review this document.

Insurance coverage in fertility care is not as straightforward as in most other areas; for example:

  • Many times there is coverage for testing to determine why you are infertile, but no coverage for treatment.
  • Many times payment depends on why the service was performed.
  • Many times the information we get from your insurer over the phone is incorrect or incomplete.

To best serve you, we have developed this approach:

When you become a patient at Kofinas Fertility Group, we contact your insurance company to obtain information regarding the coverage you have for fertility care. We have developed a list of questions that we ask in order to understand the nature and extent of your coverage.

Unfortunately, this “verification” of benefits does not oblige insurers to pay. Insurance companies protect themselves by stating that verification of your insurance coverage by them is not a guarantee of:

  • Payment
  • What is actually covered and not covered

Because of this disclaimer, even when they have told you or us that a service is covered, there is no obligation for them to pay. The true determination of whether a service is covered is made at the time the claim is received by the insurance company. Whether insurance will pay is dependent on whether:

  • The service you received is covered by your plan
  • The reason for the service (the diagnosis) is covered by your plan
  • The appropriate deductibles and co-pays have been met
  • “Preexisting condition” exclusions apply

Further complicating payment, some plans require that:

  • You have experienced infertility for a specified amount of time before services will be covered
  • The infertility is not due to prior elective sterilization
  • Certain treatment steps should be taken before other treatment steps will be covered. This may not always be consistent with the treatment plan that we believe is best for you. For instance, some companies will pay for IVF treatment, but only after three tries of gonadotropin cycles have failed.

There may be occurrences where your insurance company denies payment and deems that a service “is not consistent with the diagnosis” assigned to you.

Claims Filing

  • We will be happy to file a claim for coverage of rendered services with your insurance company. Your plan must provide benefits for the service provided for the reason it was provided, and there must be no other restrictions on covered services of which we are aware. We will collect any required co-insurance at the time of your visit.
  • Occasionally, when the doctors review lab results, they determine that another test is needed to make a complete evaluation. When this occurs, the charges for the additional test will be posted to your account at the time test is ordered.
  • Occasionally, our audits detect that services were incorrectly posted to your account, resulting in overcharges or undercharges. When we identify such errors, we will correct your account, resulting in a credit or balance.

As discussed prior, there are times when insurance companies process a claim in a manner different than expected. In these cases, be aware of the following:

  • A claim may be completely denied with no payment made, which makes you entirely responsible for the charge.
  • A claim may pay differently than was anticipated, which also makes you responsible for a larger portion of the charge than expected.

Even though your insurance company communicated to us and we in turn communicated to you that a given service or set of services is covered, this IS NOT A GUARANTEE BY US of your insurance company’s coverage for that service or set of services. If your insurance company denies coverage for any reason, you are responsible for full payment of the services billed. Because the insurance company states that the verbal information they provide is not a guarantee of payment nor can it be relied on as a guarantee of coverage, we are not responsible for any statement made by your insurance company, nor any statement made by us to you based on information given to us by your insurance company. It is very important for you to understand that the only TRUE representation of whether a given service is covered is when your insurance company actually processes the claim.

When a claim is denied, we will first try to understand why: Was the claim processed correctly? Were the appropriate diagnoses used? Were benefits incorrectly stated to us at verification? Typically an insurance company will send an EOB (“Explanation of Benefits”) that outlines what they paid and didn’t pay and why. If we believe there are errors in the claim, we will resubmit.

However, if there are no errors, then we will make the corresponding adjustment to your account, determine the portion of the charge you are responsible for, and post this portion to your account.

As stated previously, there are times when an insurance company states that the test or procedure performed is not consistent with the diagnosis assigned to you. The practitioners at the Kofinas Fertility Group order services to be performed when they determine that they are important in the diagnosis and treatment of the patient for the particular circumstances of the patient. When your insurance company denies payment and renders the decision that the services are “not consistent with the diagnosis,” it has decided otherwise.

When services have been ordered and/or performed by a Kofinas Fertility Group practitioner, and your insurance deems the services to be “inconsistent with the diagnosis,” your practitioner has deemed them to be important in your diagnosis and treatment and for your particular circumstances. You will be responsible for the payment for these, should your insurance company deny payment and state that these services are “inconsistent with the diagnosis” assigned to you.

There are instances of charges being generated or recognized on days when there is no office visit scheduled. With the very busy lives of our patients, it is difficult to reach each patient to come in and settle balances as they arise. Therefore, it is our office’s policy to require a credit card authorization be maintained on file so that your balances can be settled as they occur. Our patients find this convenient.

When these cases arise:

  • We will call you before making any charge in excess of $500.
  • We will call you before making any charges to a debit card, regardless of amount.
  • We will call you before making any charge for a service provided more than 6 months ago.
  • We will mail you a copy of your credit card receipt and your statement on the day the charge is made.
  • An authorization form will be supplied to you and your spouse for your signatures.

Outside labs may be used for necessary testing. You will receive a statement from that lab, which you will be responsible for paying.

Insurance companies often perform audits of paid claims. These audits can be performed for up to two years from the latter of the following: (a) the date of service, (b) the receipt of the claim, (c) the payment of the claim, or (d) the receipt of an appeal. When an insurance company performs an audit and determined that claims were paid in error and should not have been, the insurance company contacts us for a refund of the monies they paid. They then direct us to collect for these services from the patient. Unfortunately this may mean that for a period of up to two years after any one of the above listed events, your insurance company may reverse their decision. If this should occur, we will then contact you for payment for these services.

Should you have an outstanding balance on your account that is your responsibility and that is greater than 30 days old, we will assess simple interest on the unpaid balance at the rate of 1% per month. This represents an annual interest rate of 12%.

When your co-pay, co-insurance or patient responsibility balance for the day’s visit is not paid at the time of service delivery, we will assess a $25.00 administrative billing fee and subsequently bill you for the unpaid amount.

Unfortunately, managing insurance benefits is often troublesome in fertility medicine. For more information about our insurance policy, or to request an appointment, call 212-878-7677. You can also schedule an appointment using our easy online form.

Give yourself a great opportunity to start your family.

While most couples believe that you can’t put a price on a loving child, in vitro fertilization (IVF) can be a strain on your finances and is not a guaranteed procedure. Completing a series of expensive IVF cycles and still not getting pregnant is a worst-case scenario for many couples. Here at Kofinas Fertility Group in New York, we make your baby our priority, and we are highly sensitive to the risks involved, which is why we offer a 100% refund program.

 

For couples who medically qualify, we offer up to three fresh IVF or fresh donor-egg cycles — and as many frozen embryo transfer cycles as needed until you have achieved a viable 14-week pregnancy — for a fixed discounted fee.

 

What is the Insured Success IVF 100% Refund Guarantee Program?

Our Insured Success Program is an alternative to traditional fee-for-service payment for IVF. Many couples do not have insurance coverage that pays for IVF. As a result, the financial implications can be overwhelming should you require more than one cycle. Couples who choose this option and conceive in their first treatment cycle will end up paying higher costs than in the fee-for-service payment option, but couples who require more than one fresh IVF cycle to conceive will save considerable money.

It is important to understand that the Kofinas Fertility Group is not guaranteeing the success of the treatment. Instead, we are offering this program as a way to limit the financial risk for couples for whom a viable 14-week pregnancy is not achieved. This program, therefore, reduces the amount of money you have "at risk" for up to three cycles and fixes the cost of treatment.

 

How does the program work?

If you don’t achieve a viable 14-week pregnancy or complete all available frozen embryo transfer treatment cycles, we will give you back 100% of the program fee. It’s up to you if you want to pursue other options such as egg donation (if you did not succeed with your own eggs), embryo donation, or adoption at that point.

We include many common costs, including the egg retrieval and embryo transfer procedures, as well as laboratory procedures such as an intracytoplasmic sperm injection (ICSI), cryopreservation (freezing) and thawing of embryos.

By us sharing the risk with you that the treatments won’t work, this program reduces the amount of money you have at stake for the treatment cycles and fixes your costs. Sharing the risk demonstrates that we are proud of our IVF pregnancy success rates and have confidence in our diagnosis and treatment services.

 

Do I qualify for the program?

We will screen couples for the program in exactly the same way that we diagnose couples who have infertility and/or recurrent miscarriage, including testing for diminished ovarian reserve, checking the female for anatomical problems and checking the male for sperm factors. Couples who complete the recommended evaluation and who are good candidates for IVF may be considered for the program, with final eligibility determined by our physician panel.

Candidates for the program are chosen based on the following criteria:
  • Women’s age – All IVF cycles must be completed prior to the woman’s 38th birthday if she is using her own eggs.
  • Day 3 hormone tests – FSH less than 10 mIU/ml and estradiol less than 40 pg/ml.
  • Donor egg must be used if the woman is over 37 or if there is abnormal ovarian reserve.
  • Adequate sperm count or the ability to have adequate sperm, even if ICSI or sperm retrieval is necessary. Donor sperm may also be used.
  • Normal uterine cavity
  • No evidence of hydrosalpinges
  • Normal body mass index (BMI)
  • Nonsmoker and no illicit substance use
  • Medical clearance for chronic illness(s)
  • Willing to cryopreserve embryos
  • Normal follicular count
  • Normal AMH levels
  • Normal Clomiphene Challenge Test (CCT)
  • Cannot have begun more than two IVF cycles prior to enrollment in the program
Acceptance into this program is at the sole and subjective discretion of the Kofinas Fertility Group. Please remember that making a determination about your participation in this financial program is not a clinical determination of your chances of success with IVF. All pre-cycle testing must have been completed no earlier than six months prior to enrollment.

 

IVF services included in the Insured Success 100% Refund Program fee.

The IVF cycle fee includes one (1) fresh cycle and unlimited frozen cycles (using all frozen embryos) until a viable 14 week pregnancy is achieved. all cryopreserved embryos have been used, from the start of medications to the first blood pregnancy test. This includes:
 
  • Oocyte retrieval and embryo transfer procedures
  • IVF facility fees for oocyte retrievals and embryo transfers
  • IVF laboratory services included
  • Embryo culture
  • ICSI, if appropriate
  • Blastocyst culture, if appropriate
  • Assisted hatching, if appropriate
  • Embryo cryopreservation
  • 6 months embryo storage
  • One B-hcg (pregnancy test) and one pregnancy ultrasound

Services NOT included in the Insured Success Program.

  • IVF pre-cycle screening tests and office visits
  • Medications and their administration (injections)
  • IVF and FET cycle monitoring expenses
  • All non-IVF surgical procedures such as laparoscopy, myomectomy, surgical procedures on fallopian tubes and ovaries hysteroscopy, D&C, etc. (these procedures are usually gynecologic or obstetric in nature, and are covered by existing health insurance)
  • Costs of obtaining donor sperm, or costs for the surgical sperm retrieval when necessary
  • Anesthesia fees for egg retrieval or embryo transfer
  • Ultrasound monitoring of early pregnancy
  • Any medical services provided for obstetrical care, or for complications related to the IVF process, such as treatment of ovarian hyperstimulation syndrome, ectopic pregnancy, miscarriage, or other pregnancy complications
  • Storage of cryopreserved embryos that may still remain after a viable 14-week pregnancy is achieved
  • Future embryo transfers after a pregnancy is delivered (after a viable pregnancy is achieved)

 

Withdrawal from the Program.

The patient is under no obligation to complete all three IVF treatment cycles. Patients can choose to withdraw from the program at any time, for any reason. In that situation, after you have used all your frozen embryos in conception attempts, we will refund the program fee minus the cost of the number of fresh IVF treatment cycles performed at the time of your withdraw – according to fee for service. Any unused balance remaining at the time of cancellation will be refunded. No balance will be due, however, if the fee for service equivalent amount for services already received is greater than that already paid into the contract.
 
Just as a patient has the right to withdraw from the Insured Success Program, the Kofinas Fertility Group reserves the right to withdraw a patient couple from the program. In that situation, the patient will receive the full 100% refund, and there will be no charge for services already received by the patient.

 

Disadvantages of the Insured IVF Success Program.

The IVF cycle fee includes one (1) fresh cycle and unlimited frozen cycles (using all frozen embryos) until a viable 14 week pregnancy is achieved. all cryopreserved embryos have been used, from the start of medications to the first blood pregnancy test. This includes:
 
  • Patients who succeed after their first treatment cycle or first frozen embryo cycle will have paid more than the standard fee for service.
  • Certain costs still must be paid (see “Services NOT Included” section above) for each fresh or frozen treatment cycle, such as the cost of the fertility medications.
  • Requires a personal commitment and determination to complete all of the fresh and frozen IVF treatments within the 12-month contract period.
  • Some women will not produce an adequate number of quality fresh embryos for both a fresh IVF cycle and a cryopreservation (frozen embryo) IVF cycle. Therefore, they will not have as many opportunities to conceive under the plan. The refund is still given if three fresh cycles fail to produce a viable 14-week pregnancy.

 

Proper HealthCare Lending Fertility Procedures and Surrogacy

For more information about our ovulatory function evaluation process, or to schedule an appointment, call 212-878-7677. You can also schedule an appointment using our easy online form.

 

New York State Department of Health Infertility Demonstration Program

 

Kofinas Fertility Group participates in the NYS Department of Health Infertility Demonstration Program, which provides financial support to insured patients without coverage for IVF and gamete intrafallopian tube (GIFT) transfer. The program also covers qualified privately insured individuals whose insurance for these procedures is exhausted or inadequate, and who have exhausted basic infertility services.

 

Under this program, individuals with insurance but without full infertility coverage (including In Vitro Fertilization – IVF) can obtain State of New York Department of Health financial support for an IVF cycle. The patients must meet certain criteria including being a New York State Resident between the ages of 21-44, be clinically infertile and other clinical and program criteria.

 

Services will be paid by the NYS, through the providers, with the exception of any insurance reimbursement available, and a cost sharing amount that the patients will be required to pay. This cost sharing amount varies by the patient’s household income and the cost of the procedures, but cannot exceed ten percent of the patient’s gross household income in any one year. Financial support is available on a sliding scale basis and extends to patients with household income up to $200,000. Patients interested in determining whether they are eligible for participation in the program should contact our office at 212-878-7677.

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